The present invention relates to a holding system for surgical accessory instruments as they are employed especially in minimally invasive surgery, preferably in solo surgery as it is called.
For carrying out complex surgical operations in arthroscopy, a plurality of different instruments and optical equipment are required. Such instruments include so-called active instruments, which are actively employed by the operating surgeon for carrying out surgical measures, and passive or accessory instruments which have the function of enabling the active instruments to be used. Such accessory instruments typically include incision flushing devices, optical devices, and the like.
In clinical use the optical equipment and the accessory instruments are usually held by an assistant and manipulated upon the operating surgeon""s request. In order to facilitate or replace the assistant""s rather static work, holding arms and support devices for holding the primary surgical instruments during the surgical procedures have been employed in practice and are known from the prior art. The surgical instrument holding devices of the prior art are rather complex and are rather difficult to sterilize prior to use. The holding devices are frequently covered by sterile films during use which further complicates the ability of the surgeon to manipulate them during the surgery.
It would be desirable to provide a relatively uncomplicated and easily sterilized arthroscopic instrument holding device which is sturdy in construction, and can be easily used by the surgeon during the arthroscopy procedure.
This invention relates to a generic instrument holding system which can be easily sterilized, is easy to position, and can stably support and position the surgical trocars in a desired position during the arthroscopic surgery. This invention relies on the fact that internal body cavity walls, for example, the abdominal wall, has a certain intrinsic elasticity which permits a minimum tension to be imparted to the body cavity wall in the direction of the plane of the body cavity wall without the risk of rupturing the body cavity wall. This allows the stationary point of the instrument holding devices to be spaced slightly apart from the patient""s body cavity wall so that the entering point of the body cavity wall through which the surgical instruments are inserted is only minimally moved during the surgical procedure due to the instrument lever arm conditions which are established by the holding device. The extent of movement of the tissue at the body cavity entering point does not exceed the extent of movement that would result in shearing of the body cavity wall, thereby avoiding rupture of the body cavity wall during manipulation and positioning of the surgical instruments within the body cavity.
The positioning of the pivotable swivel part of the holding device away from the body cavity wall enables achievement of a considerably simplified design of the instrument holding arm in that the swivel point of the holding arm does not need to be coexistent with the invariable entry point into the body cavity wall, but the swivel point instead can be very close to or located in the area of the holding arm which engages the surgical instrument during use of the system. The system of this invention enable the use of plural holding and instrument position devices to be used during a surgical arthroscopy procedure and enables the surgeon better access to the patient than when a surgical assistant is present. The instrument holding system of this invention also ensures that the adjunct instruments used in performing the surgery will be stably held in place relative the incisions irrespective of the weight of the various adjunct instruments that are needed during the surgery.